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Reactive Attachment Disorder & Disinhibited Social Engagement Disorder Criteria

Jamie Marich, Ph.D., LPCC-S, LICDC-CS, RMT, edited by C. E. Zupanick, Psy.D.

This section is meant to be an informative guide only. It is not intended for self-diagnosis. These diagnostic summaries are only meant for educational purposes, not diagnostic ones. If you believe that these patterns of symptoms describe you or someone you love, seek out a professional opinion by a treatment provider who understands trauma.

Reactive Attachment Disorder & Disinhibited Social Engagement Disorder

The absence of adequate caregiving during childhood is a diagnostic requirement of both the reactive attachment disorder and disinhibited social engagement disorder. Because there are many similarities between these two diagnoses, they will be described here together:

  • Both are diagnoses intended for children under the age of 18. To qualify for either diagnosis in the DSM-5, there must be an attachment-related trauma that occurred before the age of 5.
  • Social neglect or deprivation in the form of persistent lack of care for basic emotional needs such as comfort, stimulation, and affection;
  • Repeated changes in primary caregivers that limit opportunities to form stable attachments;
  • Rearing in institutional or other unusual settings that severely limit opportunities to form close attachments.

Children with reactive attachment disorder demonstrate limited emotional responsiveness. Some examples include a lack of remorse, or an inability to register any emotion in situations that might usually elicit an emotional response. For instance, if I suddenly snatch a favorite toy from a child, most children would minimally express some form of protest. However, a child with reactive attachment disorder may simply stare blankly, and pick up another nearby toy to play with. While their range of emotion is limited, they sometimes experience episodes of irritability, sadness, and fearfulness even when there is no apparent reason for these reactions. A child with reactive attachment disorder may be unable to form close attachments with others. They do not appear to want or need comfort or support from caregivers. Other examples of how trauma-related emotional distress may manifest in children are covered in the previous sections describing trauma symptom clusters.

Children with disinhibited social engagement disorder are quite the opposite. They may be over-zealousness in their efforts to form attachment to others. They may willingly, and without question, wander off with strangers. They may behave in an overly familiar manner with unfamiliar adults, such as lavishing them with hugs and other forms of physical or verbal affection. Clearly this places them at greater risk for victimization. Impulsive or acting out behaviors can show up as symptoms in this diagnosis, in addition to the overly needy or clingy behaviors that are not better explained by culturally appropriate norms.

DSM-5 (APA 2013) indicates that some behaviors we may normally associate with the hyperactivity component of ADHD may be better categorized as disinhibited social engagement disorder. This is particularly true if there is a history of inadequate caregiving and social neglect. Likewise, some of the social awkwardness or inability to read social cues that we might associate with the autism spectrum disorder may be better explained by this diagnosis, especially if there is evidence of inadequate care or other trauma.

So far, we have reviewed the major diagnoses covered in the DSM-5 (APA 2013) chapter of Trauma and Stressor Related Disorders. It is important to note that other diagnostic categories, covered in other chapters of the DSM, may have trauma, abuse, neglect, or other adverse life experiences as causal, or exacerbating factors. Some examples are: mood disorders such as depressive disorders and bipolar disorder; anxiety disorders and phobias; dissociative disorders; and personality disorders. As we've emphasized throughout, if these patterns of symptoms resonate with you, we recommend consultation with a mental health professional.

Keep in mind, when we read articles and descriptions online, it may seem like everything applies to us. This is a common phenomenon with trauma survivors because unhealed trauma can affect nearly every aspect of life.